UK - Lucy Letby - Post-Conviction Statutory Inquiry

[Parker Knoll]

Eughhhh ! If you want unconditional love get a spaniel !

 

[CS2C]

Or as Rachel Aviv described him “a junior doctor, whom I'll call Taylor, who had become a close friend”

Junior Doctor...Bloke is about 50 years old

 

[ColourPurple]

Junior Doctor...Bloke is about 50 years old

But I guess if you’re creating a fairy tale then “junior doctor, whom I'll call Taylor” has a better ring to it than “married, middle-aged doctor, whom I’ll call Clive”!

 

[katydid23]

Dr Breary also suspects Lucy letby was harming babies at the CEST before June 2015 when we know she murdered baby a by injecting him with air, now essentially he said some issues on the unit had become normalized=== and he referred to babies having blocked tubes or suddenly stopping breathing which at the time he said the nurses didn't think was abnormal so they didn't report or flag them...

... but now looking back he says he suspects some of these incidents were caused deliberately by Lucy letby== here's how he put it in his evidence-----" I think it's it's likely that letby didn't start becoming a killer in
June 2015 or didn't start harming babies in June 15 and I think it's likely that ---she-- her actions prior to then over a period of time changed what we perceive to be abnormal...

[...]

now so before the break we got to that CQC inspection at the hospital

and we know that at around the same time Dr B and Mrs Powell with the help of a neonatologist from another hospital had also completed a thematic review into all 10 baby deaths across 2015

staff rotors were also highlighted and they showed that Lucy Letby was on duty for all of them apart from one...

now Dr Brewery said he sent that review to the senior managers and asked for an urgent meeting... he said he believed they had enough evidence for the police to be called in at that point ---but we know they weren't called in, and in fact there was a further delay and it was May before that meeting was organized.

by then he said he and Mrs Powell were at loggerheads and the meeting got quite heated because she was steadfast in her support for Lucy Letby, but he said he still had hope at that stage that the senior managers would take control of
the situation...
Q: what action did you think was necessary to make the unit safe at this point ? what what do you think in retrospect you might have been saying at that meeting ?

A: "I thought that the exx should have been discussing it outside the hospital with with experts whether that be safeguarding experts or um the police or onious England whoever it just felt like so much of a a significant concern that doing nothing didn't seem to be an option..."


as we know though nothing happened and then a month later on the evening of June the 23rd the first triplet baby o died while under the care of Lucy leby now at this point Mrs Powell and the senior managers had left for the day but Dr Brewery said he was very worried and he intended to escalate his concerns again to them the next day ...he said he didn't anticipate that Lucy leby would be allocated one of his brothers to care for but he said he now obviously regrets waiting overnight to act because we know that's when she murdered baby O's brother Baby P.

Dr BR was asked about the evidence given to the inquiry by Karen Rees, the director of nursing for Urgent Care and you may remember from last week's episode that she went to see Dr BR on the afternoon that baby P died to ask him about allegations that were being made by the Consultants about Lucy leby deliberately harming children.

Mrs Rees said Dr BR told her he had a Drawer of Doom, but wouldn't tell her what was in it. .. who do you remember using that phrase to ?

" at some point in time I think the conversation I can vaguely remember with that was with somebody who was standing
in the doorway talking I don't know whether it it's hard to imagine it could have been on that day but the point I
was trying to make was that normally that drawer is fairly unused and there were more deaths and more events ---yeah it was getting full and I think the way that that phrase has been used by Karen Ree and was used by others in the
following year or so it was belittling the concerns that we had , and distracting from the concerns that we had now after baby P's death ."

Dr Brewery said he rang the senior manager on call that night via the hospital switchboard to request that Lucy Letby be removed from working and he said by chance that manager was Karen Rees and she refused... he said he had an anxious weekend knowing that Lucy Letby was on duty... and we know that over that period She allegedly attacked Baby
Q--- although we also should say she wasn't ever convicted of that at her trial ...

by the Monday the Consultants were still very concerned so they went to warn Harvey and asked him to remove her from
the Ward ...we know eventually that did happen because when she came back from holiday she wasn't allowed to return.

Dr Brewer said he didn't think it was the right thing for the Consultants to go to the police directly themselves because
it was such a big step but he said it was clear that within a few days of the triplet deaths the senior managers were
looking for reasons not to go to the police ...

Miss Langdale asked him about a meeting between the consultants and Executives on June the 30th ...your recollection of the meeting was that Executives were looking for reasons to either not go to the police or to defer this decision ?

A: "Tony Chambers opened the meeting and explained the trust had commissioned an external review that the NNU would be regraded in the meantime..."

...I can remember us raising our concerns regarding the possibility of Letby harming the babies in the meeting---
Tony Chambers answered by saying that would be convenient ...

Q: what did you think that meant if that was said can you remember it ?

A: "I can remember it vividly yes um it really struck me and it struck me that he had formed his opinions already but the impression that we're getting already three or four days into this escalation was that Mr Chambers and his colleagues felt that our actions in highlighting the commonality of Letby and asking to be removed from the unit was a convenient in his words way of maybe hiding our own failings"

Dr Brewery also said he was completely excluded from a forensic drill down of the deaths that Mr Harvey decided to undertake while Lucy Letby was on her two week holiday .

" I was completely excluded from any of those investigations uh as far as Ian Harvey was concerned and it just felt ridiculous actually and I had expressed to him concerns that he he trained as an orthopedic surgeon and he was taking on a review of this very complex case with hardly any Neonatal experience "

so we know that by this point the manager still hadn't called the police and instead they commissioned a review by the Royal College of Pediatrics and child health and later they asked Dr Jane Horden to carry out a case Note review of the
individual baby deaths "

but Dr Brey said that September to December that year was a really difficult time --the Consultants were being accused of mistreating Lucy letby-- they'd been ordered to take part in her grievance process and they were also not being told what the reviews had found ===he said "the situation seemed to be turning into a narrative against us rather than being focused on the cause of the baby's deaths " and he said the atmosphere was intimidating and he started to worry about his job.

" I think I mentioned my statement obfuscation and delay and secrecy seemed to be the theme of those months "--he said he was warned against talking about Lucy letby

ian Harvey and that trust between the consultants and the nursing team had become fractured around this time in early 2017 he said


he also felt troubled about the fact that parents of the babies whose deaths were under review were being told
nothing about what was going on he said he recalled a conversation with parents of a baby who died who wasn't part of
the charges against Lucy leby it's almost they could tell that something wasn't quite right um but they didn't
quite have you know their senses were up but they they didn't spe didn't know the specifics or the worries that we had
um so I could reassure them about the care their baby received and and their concerns and reassure them about that
but it it didn't sit with me at all well and um I felt very uncomfortable doing
it but I didn't feel in a position to let them know that I I was worried about a nurse murdering their baby as well as
others I didn't think because then it would be in the public domain

then he was asked about that meeting that the Consultants were called to on January the 26th 2017 by the senior managers....

 

[Marantz4250b]

No married man invests that much time and effort (including trips to London and visits to her house) to merely discuss the flowers in Cockington! Don’t get me wrong, I doubt they were swinging from the chandeliers. Probably more like the infamous scene with Will from the Inbetweeners, but still…

Was it ever confirmed that he went to his house?

For various reasons I can very well believe that nothing sexual went on, tbh.

 

[Parker Knoll]

Yes - neighbours said she was seen with a “ man “ at her house many times.
Granted it could have been anyone in trousers tbh.

 

[Tortoise]

Was it ever confirmed that he went to his house?

For various reasons I can very well believe that nothing sexual went on, tbh.

Letby is asked about a doctor who she was friendly with. We can't name him for legal reasons.

She says it was a friendship.

Myers asks: "Anything more than a friendship?"

Letby replies: "No."

"Sometimes he'd come to my house, we'd go out for coffee, or walks," Letby adds.

Lucy Letby: Being accused of babies' murders was devastating, says nurse

The nurse breaks down in court as she denies murdering seven babies and attempting to kill 10 others.

www.bbc.co.uk

 

[ColourPurple]

Was it ever confirmed that he went to his house?

For various reasons I can very well believe that nothing sexual went on, tbh.

She confirmed in court that he went to her house. No evidence she went to his but then that might’ve been a bit awkward with his wife and kids living there. We never did find out what she said to his wife when she was “targeted by LL on social media” either. Then there were the messages “of a social nature” that went on in the early hours between them that the jury weren’t allowed to hear.

Killer nurse created 'crisis situations' to attract married colleague

The nurse and the medic went on day trips to London, met up for walks and meals together in their free time away from the hospital, and swapped hundreds of messages on Facebook,

www.dailymail.co.uk

 

[katydid23]

cont/part 2---Daily Mail YouTube for Dr Breary

then he was asked about that meeting that the Consultants were called to on January the 26th 2017 by the senior managers....

this was the meeting you'll remember when the Consultants were told that no wrongdoing had been found in the reviews
and Tony Chambers apparently thumped the table and said he was drawing a line under the Lucy issue

He also told the Consultants they would have to apologize to her ...

and Dr BR was damning in his assessment of this meeting--
Q: secondly you say in your statement the tone of the meeting was aggressive intimidating and direct --we know a statement was read out at that meeting from Letby by Karen Rees, is that right ?

A: that's correct yes

Q: what did you make of that at the time ?

A: the whole meeting felt choreographed and Miss Reese was quite dramatic in her reading of it we
were all quite stunned...
..really um as a sort of um synopsis of Executive Behavior , I can't imagine as an example of anything more incompetent in the history of the NHS


by March he said the Consultants were becoming desperate they felt their jobs and careers were under threat they were scared that Lucy Letby would be allowed back to the unit and they felt they'd done everything reasonable to raise concerns with the senior Executives without any success ---he said the pressure
was intolerable and he even considered trying to get a job at a different hospital so he could raise his concerns
from the outside
...he also agreed the consultant's concerns were put to one side in case they caused reputational damage to the hospital
having lived through all this I'm a little bit skeptical as whether that was a true concern or whether is more on an individual basis the people making that decision looking after themselves and trying to protect themselves through this and particularly if they've not responded to our concerns as early as they should have done and he was asked
if there was an anti-d doctor agenda among some of the executive team because most of the senior managers at the

hospital including Tony Chambers were former nurses I think um it's allowed
the executive body particularly Mr Chambers to give more credibility to the views of some senior nursing staff such as Arian paul and and Murphy and Karen rees
in preference to the consultant body's concerns...

and I think in addition to that the concerns of Letby's parents and Letby herself above our concerns he was also
asked by Richard Baker KC who represents some of the families about rumors that some of the managers in the hospital
were members of the Freemasons---
Dr Brewery said Steven Cross the hospital's head of corporate and legal Affairs had risen up through the hospital ranks quite quickly and there were suspicions about this ---now just a quick reminder here the inquiry been told that Mr Cross was an ex- police officer and it was he who advised the senior managers not to go immediately to the police he said that there would be blue and white tape everywhere and the publicity would be a disaster for the hospital ...

Dr Brewer said he found out later that Mr Cross had been demoted from the rank of Chief Inspector to Constable when he worked in cheshir police it wasn't known why he was demoted but he was deemed to be a fixer of problems at the hospital and the executive team relied on him a lot---

Q: you, you'd had a sense that there might be some deals going on behind the scenes some element perhaps of corrupt Behavior?

A: people had that impression and there was certainly rumours of that kind uh C yes

Q: and the inquiry heard yesterday in fact that Mr Cross was a Freemason and he instructed another senior Freemason a
criminal Barrister called Simon Medlin Casey to talk to the Consultants to see if there was enough evidence to Warrant

them going to the police now Mr medland who's now a judge said he belonged to a different Masonic Lodge to Mr Cross and they were not close friends and he insisted there was no Masonic context to this instruction ...

 

[Marantz4250b]

Yes - neighbours said she was seen with a “ man “ at her house many times.
Granted it could have been anyone in trousers tbh.

I'd always taken that to be her dad most likely.

 

[marynnu]

Junior Doctor...Bloke is about 50 years old

He was a junior doctor then, to be fair!

 

[Tortoise]

Sir Duncan Nichol sworn in - follow his evidence live
10:04​

Image source,The Thirlwall Inquiry
Image caption,
Nichol is called to the witness box and takes the oath


Sir Duncan Nichol has just been sworn in and is about to give evidence to the Thirlwall Inquiry.

As a reminder, we're not able to stream proceedings live, but our correspondent Judith Moritz is there to provide rolling updates.

Nichol was NHS chief when killer nurse Beverley Allitt convicted
10:17​

Judith Moritz
Special correspondent, reporting from the inquiry

Sir Duncan Nichol is being questioned by inquiry counsel Rachel Langdale KC. She starts by giving a summary of his career.

He was the chairman of the board at the Countess of Chester Hospital between 2012 - 2020.

He had previously been the chief executive of the NHS Management Executive between 1989 and 1994 - this included the period when nurse Beverley Allitt was convicted of murdering babies in her care, at Grantham in Lincolnshire.

After Allitt was convicted, there was an inquiry. Nichol was tasked with circulating its conclusions, and wrote to people throughout the NHS to be certain that the lessons of the inquiry were absorbed across the NHS.

What did the Allitt report say?
10:19​

One of the recommendations in the Allitt report - put together by Sir Cecil Clothier - reads as follows:

Quote Message
"The main lesson from our inquiry and our principal recommendation is that the Grantham disaster should serve to heighten awareness in all those caring for children of the possibility of malevolent intervention as a cause of unexplained clinical events."

He was asked to circulate this point of learning by the then-Health Secretary, Virginia Bottomley.

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk

 

[Tortoise]

Nichol visited neonatal unit 'two or three times' when Letby operating
10:29​

Judith Moritz
Special correspondent, reporting from the inquiry

Image source,The Thrilwall Inquiry

Nichol became chairman of the board at the Countess of Chester Hospital in 2012.

He is asked about his relationship with the former chief executive, Tony Chambers, which he says was "professional and warm".

“We met very frequently", Nichol tells the inquiry. "I was in the hospital two or three times a week and I would meet Mr Chambers on some if not most of those days".

"We had informal discussions, we would do walkabouts together in the hospital.”

Asked if these would ever occur within the neonatal unit - where Lucy Letby worked - Nichol says "yes", including "two or three times over a two or three year period" during the events being examined by the inquiry.

10:35​

At the time that Lucy Letby was on the neonatal unit, the Countess of Chester Hospital was fundraising for a new unit.

"I remember a very busy and crowded unit and a sense that we were looking forward to the new unit we were seeking to fund," Nichol says, somewhere "with more space".

Risks not logged and escalated in Letby situation, says ex-hospital chair
10:38​

Nichol is asked about the way risk management worked within the hospital’s management structure.

"The risk management system works on risk issues being logged at ward level and escalated to the Quality and Safety Committee," he says.

And with Lucy Letby, "that did not happen”.

In July 2016, 'reputational' risk logged over ‘apparent’ rise in baby deaths
10:43​

Image source,The Thrilwall Inquiry


The inquiry is shown an entry which was made on the hospital’s Urgent Care Risk Register in July 2016, where the risk of an "apparent" rise in baby deaths is logged as reputational., external

Rather than, for example, a risk to patient safety.

Nichol is asked what he makes of the way the risk was recorded.

"I think it’s inappropriate," he says, "I don’t think a matter of patient safety and the explanation of that should present any reputational risk to the hospital."

"I think it raises important questions of how we communicated with the community, and in the case of neonates, with the parents."

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk

 

[Tortoise]

Did consultants have 'genuine misgivings' about Letby?
10:50​

Nichol tells the inquiry that he had never discussed safeguarding - in particular in relation to the neonatal unit - with Alison Kelly, the executive lead for safeguarding at the hospital,

Rachel Langdale KC asks if he doubted any time that consultants "had genuine misgivings" about Lucy Letby.

"No", Nichol says, "I genuinely felt that they had those misgivings".

'I thought we had a happy, cohesive team'
10:55​

Inquiry counsel Rachel Langdale KC asks Nichol for his opinion on the relationship between doctors and nurses at the hospital while he was chair.

"Generally, I thought we had a happy team that worked together," he says.

"You’ll always find a hot spot or two somewhere, but in general I thought we had a cohesive team that was working as a team across professions."

Nichol: Documentation over baby death rise 'not good enough'
11:00​

Image source,The Thrilwall Inquiry

The quality of note-taking and documentation relating to reviews that were conducted into the rise in neonatal deaths at the hospital wasn’t good enough, Nichol tells the inquiry.

“They were difficult to understand, not all of them made it easy to connect the point to who was taking action - I found them difficult to follow.”

He agrees that they notes should have been typed up with a clear chronology and an action plan with clear responsibilities.

“From the written notes it wasn’t entirely clear to me who was following up, and I had no sense of whether that was happening or not.”

Medical director gave inaccurate statement to hospital committee, says Nichol
11:08​

The inquiry now moves on to a meeting of the hospital's Quality, Safety and Patient Experience Committee, which was addressed by then-medical director Ian Harvey on 19 September 2016.

This was shortly after an external organisation - the Royal College of Paediatrics and Child Health (RCPCH) - had been invited into the hospital to review the neonatal unit.

Harvey told this meeting that the external review “had not raised any immediate concerns”, but in fact the RCPCH had recommended that there should be an immediate HR process to investigate the allegations against Lucy Letby.

Nichol is asked if, in the light of this, he believes that the statement Harvey made to the committee was accurate. "No," he says.

Nichol first learned neonatal unit downgraded in June 2016
11:20​

The inquiry is now shown handwritten notes from a meeting between hospital executives and Sir Duncan Nichol on 30 June 2016.

In this meeting, then-medical director Ian Harvey is seen to have said that it couldn’t be accepted that the neonatal unit was safe.

Nichol says this is the first time that he had heard discussion of the unit being downgraded - meaning it would care for babies who were less premature.

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk

 

[Tortoise]

'This is a Beverley Allitt / Shipman situation'
11:25​

Moving on now to a different meeting later that same day, which Nichol attended along with hospital executives and some doctors.

One doctor, Dr Jim McCormack, is recorded as saying: "This is a Beverley Allitt / Shipman situation” - referencing Allitt, a nurse convicted of murdering babies in her care, and Dr Harold Shipman, who was responsible for the deaths of up to 215 patients.

Rachel Langdale KC asks Nichol: “Did that make you sit up when you heard that?”

He says he doesn’t recall the doctor making the comment.

Inquiry takes short break
11:28​

Nichol is asked about the creation of a "silver command" unit within the hospital in July 2016, which included him, some executives and other managers.

He says it was established in the wake of the decision to downgrade the unit to care for less premature babies.

“I think it was in anticipation of the actions that would be taken in that July and August."

"A great many of them would have a great effect on the hospital, the community, the mothers, and we just needed to prepare for what would be a very demanding communications exercise.”

The inquiry is now heading on a short 15 minute break.

Press release on downgrading unit did not mention doctors' concerns
11:52​

The hearing restarts and Sir Duncan Nichol is asked about a press release the hospital put out in July 2016, external to communicate the decision to downgrade the unit.

Rachel Langdale KC, counsel to the inquiry, asks whether it was "transparent or accurate" to not mention that some paediatricians were concerned about the actions of a nurse on the ward.

“I think that at the point we were it was the right communication, it was transparent," Nichol says.

At the time enquiries were ongoing, he explains, and they believed that the increase in mortality on the neonatal unit could be down to “multi-factorial” reasons.

“I am content that was a fair press release at that time”, he says.

Doctors' Letby suspicions the 'elephant in the room' at board meeting
11:59​

The counsel to the inquiry now asks Nichol about an extraordinary meeting of the hospital trust board, which was called on 14 July 2016 - two of the unit's paediatricians, Dr Stephen Brearey and Dr Ravi Jayaram were there.

Nichol says he remembers Jayaram using the phrase "elephant in the room" at this meeting, to refer to their suspicions about Lucy Letby’s association with the timing of the deaths of babies.

He adds that at the same meeting, then-medical director Ian Harvey had “drawn our attention to the possibility that multiple factors” lay behind the deaths, and had said “we cannot see a single hypothesis”.

And, he says, he was influenced by Jayaram noting police would need "hard evidence" to begin an investigation.

Where this all fits into the timeline
12:04​

To give you some idea of where this all fits into the timeline, the last murder which Lucy Letby has been convicted of is that of Baby P - on 24 June 2016.

She worked on the neonatal unit until 30 June, and then went on annual leave for two weeks.

On her return, she was moved to a clerical role in the risk and patient safety office.

This board meeting was on 14 July 2016, and a subsequent external review by the Royal College of Paediatrics and Child Health (RCPCH) was conducted in September 2016.

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk

 

[Tortoise]

12:06​

The inquiry has previously heard there was a public version of the Royal College of Paediatrics and Child Health report, and a redacted version, with references to Lucy Letby removed. The consultants were not shown the full version.

“I thought it was essential that they see it,” Nichol tells the inquiry.

Inquiry counsel Rachel Langdale KC asks if he checked whether they had, to which Nichol says no.

He adds that he doesn’t know if the full hospital board ever saw the full RCPCH report.

12:21
Nichol admits 'big' personal failure over doctors' exclusion from key meeting​

Sir Duncan is now being asked about a board meeting on 10 January 2017, at which the then-medical director, Ian Harvey, recommended that the board should be “invited to consider assisting the staff member’s return to work on the neonatal unit”.

Unlike at the previous board meeting, the consultants were not present.

Rachel Langdale KC, counsel to the inquiry, asks: "Do you think as a board it might have been helpful for you to have the consultants’ views of the adequacy of the RCPCH report?"

Nichol replies: "Yes, I do, absolutely. I regard it as personally a big failure on my part, that the consultants were present at the first extraordinary board meeting and they were not present at this one, and they should have been."

He says the decision over who attends was ultimately his.

He agrees with Langdale that the tone of this meeting was "very different from the last one" and discussed the risk to babies.

Nichol says he does not recall whether there was any discussion over what parents would be told about the impact of the report on their children.

Nichol told in 2017: 'If events still unexplained, call police'
12:30​

The questioning now moves on to the next extraordinary board meeting, in April 2017., external

At this meeting, a criminal barrister - Simon Medland KC - was invited to attend, after been asked to advise the hospital on its approach to involving the police.

Nichol says the barrister “reported back to us that he didn’t find any evidence of criminality but he used an expression that stayed in my memory".

"Along the lines that 'if events are still unexplained, the police should be called'... I wish we had had that advice in July 2016.”

Nichol asked about letter sent by Letby's parents
12:44​

Image source,Getty Images
Image caption,
Lucy Letby's parents - John and Susan - pictured arriving at court last year for their daughter's trial


The inquiry is shown a letter which Lucy Letby’s parents sent to Nichol and hospital chief executive Tony Chambers in 2017.

They wrote: “It is now one year since our nightmare began. There is a saying ‘innocent until proven guilty’ but it doesn’t seem to apply to Lucy."

In the letter, Letby's parents also requested a meeting with both of them.

Nichol says he didn't respond, and it was agreed that Chambers would meet the parents.

Asked about what level of support he thinks was being given to Letby at the time, Nichol says: "I have no insight into that".

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk

 

[Tortoise]

12:45
'Provocative and aggravating'?​

Nichol is asked about a meeting in January 2017, when a statement written by Letby was read to consultants.

Rachel Langdale KC asks if he believes that was an appropriate thing to do, Nichol says "no, I thought it aggravated matters and was provocative".

12:54
Chair apologised to doctors for not intervening sooner​

The inquiry hears about an email which Nichol sent to consultant Dr Ravi Jayaram on 25 May 2017 - after the police investigation had begun.

In it he wrote: “I want you and your consultant colleagues to know how deeply sorry I am for the personal distress that you have and are all suffering, and for my part in not intervening sooner.”

On the same day as this, Nichol went to find the doctor, and says the pair had an emotional conversation.

"I remember us putting our arms around each other," he says.

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk

 

[Tortoise]

Nichol asked about relationship with ex-hospital chief
14:28​

The inquiry resumes with Sir Duncan Nichol, the former chair of the Countess of Chester Hospital, being asked about the period, in 2018, after Lucy Letby had been arrested.

The then-chief executive of the hospital, Tony Chambers, was facing a vote of no confidence, and resigned before any vote could happen.

Nichol says he "spoke to no one to influence the vote of no confidence which I thought was going to take place”.

In his role as chair he conducted annual appraisals for Chambers, and says between 2013-16 he had “exceeded expectations”, but in 2017 and 2018 his performance “had dipped”.

Letter from Letby's parents to hospital bosses in full
14:34​

Earlier in today's hearing Nichol was asked about a letter sent to him, and hospital chief executive Tony Chambers, on 7 July 2017 from Lucy Letby's parents.

We have now managed to get the full wording of the letter, which reads as follows:

Dear Mr Chambers & Sir Duncan Nichol

It is now I year since our nightmare began.

There is a saying "Innocent Until Proven Guilty" but it does not seem to apply to Lucy. She is still the only one of all the staff on the Neonatal Unit to be singled out for punishment.

Whilst we appreciate that things cannot be finalised until the Police Investigation has ended we have to have a way of moving forward in terms of her career for however long the investigation takes.

We therefore wish to request an urgent meeting with you both to discuss what restrictions are on Lucy and what expectations she can have regarding Work/Training for the time until the Police Investigation has been completed.

We would appreciate the meeting to be as soon as possible as the anguish this situation is causing has become intolerable.

Kind Regards

John & Sue Letby

Parents of Lucy Letby

Lawyer for babies' families next to ask questions
14:35​

Counsel to the Inquiry Rachel Langdale KC has now finished her questions for Sir Duncan Nichol.

Nichol is now being questioned by Sara Sutherland, on behalf of some of the babies’ families.

Why weren't babies' families present at June 2016 meeting?
14:43​

Sutherland puts it to Nichol that the babies’ families should have been included in a meeting on 30 June 2016, when he was discussing the situation with hospital executives.

Nichols disagrees: “I am not sure at this stage whether the families should have been involved… this was the first time that I had heard anything about a spike in deaths."

"We were looking to the principal concern - the safety of babies on the unit and we had actions that we needed to take," he says.

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk

 

[Tortoise]

Doctor warned unit would remain unsafe until Letby removed
14:54​

At that meeting on 30 June 2016, the neonatal clinical lead, Dr Stephen Brearey said that whatever other changes were put into place on the unit, it would remain unsafe until Letby was moved - and that his opinion on the matter wouldn't change.

Sara Sutherland says to Nichol: “You have the head of the neonatal unit saying his opinion wouldn’t change.. so that's the date you should have called the police isn’t it?”

Nichol doesn't agree, saying that "the consensus in that meeting was that the majority - and this was from the paediatricians - agreed that the next steps were to undertake external inquiries”.

Sutherland continues, saying "these were consultant paediatricians who were clearly identifying unexplained deaths of babies on 30 June 2016, there was nothing stopping anyone calling the police was there?"

Nichol replies: "There was nothing stopping anybody calling the police."

Was the hospital chief 'a fit and proper person'?
15:01​

Image caption,
Tony Chambers gave evidence to the Thirlwall Inquiry late last month

Sara Sutherland is taking Sir Duncan Nichol through the detail of the consultants’ complaints about former chief executive Tony Chambers, which they were making before he resigned in 2018.

She asks the former hospital's chairman if he agrees that Chambers was “not a fit and proper person”, to which Nichols says he does not.

"I think he was in the middle of a process. I don’t believe the paediatricians were coerced into mediation and these were the views of the paediatricians, but I don’t fully subscribe to the view that Tony Chambers wasn’t a fit and proper person."

"We were in the middle of a process of reconciliation that had no quick fix," he says.

Questions return to killer nurse Beverley Allitt
15:04​

Nichol is now being questioned by Leanne Woods, on behalf of the second group of babies’ families. She says she wants to take him back to the case of Beverley Allitt.

Some context: Allitt, a former nurse, was convicted of murdering babies in her care in 1991. At the time, Nichol was chief executive of the NHS Management Executive, and was tasked with circulating the conclusions of the inquiry into what happened.

Woods says that "presumably it was a significant event both for the NHS and by extension you?"

Nichols replies: "Very much so."

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

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[Tortoise]

'We seriously failed babies' families'
15:19​

Although Nichol was running the NHS at the time of the Allitt scandal, and was responsible for disseminating the recommendations made by the inquiry into the case, he says it "[was] not in the forefront of my memory" when it came to the Letby situation in Chester.

Asked by Woods where the babies' families were in the big picture, Nichol says they "were not".

"We didn’t exercise an appropriate duty of candour towards the families and that was a failure. A serious failure."

I think we failed, Nichol says again
15:27​

Woods continues, asking "what more can be done" at an executive level to ensure families are not kept in the dark and are not kept outside when things go wrong?

Nichol says "we just have to reinforce the key messages of good governance and good board practices".

Asked if he has thought of anything more radical, he says "I think we failed".

He adds that while they were in the middle of a "hugely complex process" that didn't they shouldn't have kept families informed along the way.

Were families kept in dark? 'I wouldn't put it that way'
15:30​

Now the inquiry moves on to the decision to send the babies' families a redacted version of the 2016 report by the Royal College of Paediatrics and Child Health (RCPCH).

Nichol says he believes it was the right thing to do.

"And therefore keeping them in the dark?" Woods asks. Nichols says "I wouldn't put it that way".

'I'm so sorry for the unimaginable grief'
15:32​

Image source,The Thirlwall Inquiry

After questioning finishes, the inquiry chair, Lady Justice Thirlwall, gives Sir Duncan Nichol an opportunity to give a statement to the inquiry.

Nichol is visibly emotional as he says: "I’ve never encountered a situation which has generated as much angst and stress as this one".

Choking up, he continues: "I wanted to say that the Countess of Chester Hospital failed to keep babies safe in their care, and that’s something that I found very very stressful over time."

"And more importantly that caused unimaginable grief for the families whose babies died and I am so sorry that that happened in the way that it did", he says.

And with that, Nichol finishes his evidence.

This is a Harold Shipman situation, doctor at Lucy Letby's hospital warned in 2016

Sir Duncan Nichol, the former chairman of the Countess of Chester Hospital, said he did not recall hearing the comment.

www.bbc.co.uk